Haematological Malignancy Flashcards
Haematological Malignancies Epidemiology
10% of all human cancers
Occur in all age groups, including children
Adult males are more commonly affected than females.
Common cancer in children
Acute Lymphoblastic Leukaemia
Age of Hodgkin Lymphoma
Peak incidence between 18-35
Median age for MDS
73-74
Characteristics of Multipotential haemopoietic stem cell
Cant identify them down the microscope
Can identify them with immunophenotyping
Small population of the bone marrow.
They are pluripotent, and undergo self-renewal
Myeloid Malignancies
Red cells, platelets, granulocytes and monocytes
Lymphoid malignancies
B-cell to T-cell
AML Mutation
Occurs at the hematopoetic cells or the myeloid progenitor cells. Proliferation but without differentiation resulting in the accumulation of useless progenitor cells.
ALL Mutation
Occurs at the hematopoetic cells or the lymphoid progenitor cells. Proliferation but without differentiation resulting in the accumulation of useless progenitor cells.
Myeloproliferative Disorders
Overproduction but with differentiation resulting in myeloproliferative disorders.
Mature Lymphoid malignancies
Occur as the cells pass through the germinal centre of the secondary lymphoid organs.
Leukaemia vs Lymphoma
If disease occurs in the bone marrow its called leukaemia
If disease occurs in the lymphoid tissue and solid organs then it is termed lymphoma.
Acute Leukaemias
Acute lymphoblastic leukaemia (ALL)
Acute Myeloid Leukaemia (AML)
Chronic Leukaemias
Chronic myeloid leukaemia (CML)
Chronic lymphocytic leukaemia (CLL)
Malignant Lymphoma
Non-Hodgkin lymphoma (NHL) Hodgkin lymphoma (HL)
Multiple myeloma
Malignany of plasma cells
Acute leukaemia process
Leukaemic cells do not differentiate
Bone marrow failure
Rapidly fatal if untreated
Potentially curable
Chronic leukaemia process
Leukaemic cells retain ability to differentiate
Proliferation without bone marrow failure
Survival for a few years
Not presently curable without BMT
Clinical features of acute leukaemia (bone marrow failure)
Anaemia
- Thrombocytopenic bleeding (Purpura and mucosal membrane bleeding)
- Infection because of neutropenia (predominantly bacterial and fungal)
Structure of the Lymph Node
Different lymphocyte populations reside in different areas of the node – B cells in the follicles. T cells in the paracortex and plasma cells in the medulla. Within the B-cell areas different populations – Cells undergoing expansion and selection in the GCs, naive cells in the mantle zone
B-cell maturation
B-cell must display appropriate IG to the antigen to survive
Lymphoma Presentations
Nodal disease – Lymphadenopathy
> 90% HL present with nodal disease
~ 60% NHL present with purely nodal disease
Extranodal disease:
~ 40% NHL present with an extranodal component
Systemic symptoms: fever, drenching sweats, loss of weight, pruitis, fatigue
Localised and painful lymphadenopathy
Bacterial infection in draining site
Localised and painless lymphadenopathy
Rare infections, catch scratch fever, TB
Metastatic carcinoma from draining site- hard
Lymphoma-rubbery
Reactive, no cause identified
Generalised and painful lymphadenopathy
Viral infections, EBV, CMV, hepatitis, HIV
Generalised and painless lymphadenopathy
Lymphoma Leukaemia Connective tissue diseases, sarcoidosis Reactive, no cause identified Drugs
Multiple Myeloma Clinical features
Bone pain and lytic lesions Hyper viscosity syndrome Bleeding tendency Amyloidosis Renal failure Recurrent infections Anaemia
